CT Overuse for Mild Traumatic Brain Injury

Melnick, Edward R.; Szlezak, Christopher M.; Bentley, Suzanne; Dziura, James; Kotlyar, Simon; Post, Lori A.

doi:10.1016/s1553-7250(12)38064-1

Cited by 105 publications

(103 citation statements)

References 45 publications

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“…[18,19] Although the implementation of head CT rules, CCHR specifically, has the potential to increase CT use in MHI by 35%, substantial variations among countries regarding CT use in MHI, as well as awareness and the use of head CT rules have been established. [7,[20][21][22] High frequency of noncompliance with guidelines even after intensive implementation efforts has also been reported. [8] This is the first national survey specifically aimed at identifying the attitudes and practices regarding CT use in adult patients with MHI.…”

Section: B) Awareness and Use Of Head Ct Rules In Mhimentioning

confidence: 99%

Computed tomography use in minor head injury: attitudes and practices of emergency physicians, neurosurgeons and radiologists in Turkey

Ozan

Ataç²

2017

Ulus Travma Acil Cerrahi Derg

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Section: B) Awareness and Use Of Head Ct Rules In Mhimentioning

confidence: 99%

Computed tomography use in minor head injury: attitudes and practices of emergency physicians, neurosurgeons and radiologists in Turkey

Ozan

Ataç²

2017

Ulus Travma Acil Cerrahi Derg

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“…This can lead to unnecessary radiation exposure, increased length of ED stay, and increased healthcare costs. [33,34] Of note, however, in patients with moderate to major head injuries, most guidelines would recommend imaging, as the likelihood of a treatable lesion is significantly increased as the GCS decreases. For example, in one study, a GCS of 13 as opposed to 15 increased the likelihood of requiring surgery by threefold.…”

Section: Imagingmentioning

confidence: 99%

“…[36] Additionally, routine serial head CTs in the absence of a change in neurological status are not recommended. [33,36] Commonly, TBI patients present with confounding variables such as drug and alcohol intoxication. Earlier studies have described GCS calculated at 6 hours to be more reliable in necessitating further intervention.…”

Section: Imagingmentioning

confidence: 99%

“…[40,41] Of warfarin users, therapeutic INR is associated with more extensive bleeding and up to a six-fold increase in mortality. [33] Coagulation studies should be routinely performed in patients on chronic anticoagulation and in all patients older than 50 years. Corrective therapy should be administered accordingly and promptly.…”

Section: Antiplatelet and Anticoagulation Voncernsmentioning

confidence: 99%

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Traumatic brain injury: A case-based review

Escobedo¹,

Habboushe²,

Kaafarani³

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND: Traumatic brain injuries are common and costly to hospital systems. Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines. This is a review of the current literature discussing the evolving practice of traumatic brain injury.DATA SOURCES: A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses, systematic reviews, and randomized controlled trials. RESULTS:The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas, maintain systolic blood pressure above 90 mmHg, oxygen saturations above 93%, euthermia, intracranial pressures below 20 mmHg, and cerebral perfusion pressure between 60-80 mmHg. CONCLUSION:Much is still unknown about the management of traumatic brain injury. The current practice guidelines have not yet been sufficiently validated, however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury.

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“…2 In an era where healthcare spending is at an all-time high and with foreseeable significant reimbursement changes with the adoption of the Affordable Healthcare Act, healthcare institutions will need to continue to find ways to provide smarter care at a smaller price. 3 The lessons from this article could easily be applied to countless other clinical scenarios such as inappropriate ordering of head CTs in the setting of mild trauma 4 and inappropriate use of hepatocellular screening guidelines in patients with hepatitis C cirrhosis, 5 simply to name two.…”

mentioning

confidence: 99%

Capsule Commentary on Larochelle et al., Reducing Excess Biomarker Testing at an Academic Medical Center

Augustine

2014

J GEN INTERN MED

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1 test a multimodality intervention to prevent unnecessary use of CK and CK-MB testing and overuse of troponin testing in the diagnosis of cardiac chest pain. The authors modified the electronic medical record cardiac order set, removing the option for CK and CK-MB testing and promoting serial troponin ordering in adherence with established guidelines. In addition, the authors conducted informational sessions related to the above guidelines and distributed pocket cards for information reinforcement. The study, completed as an interrupted times series design, cited an absolute increase of guideline-concordant ordering of cardiac biomarkers of 38.4 % with an associated $1.25 million decrease in charges over the first year.This paper is an excellent example of how a "forced" intervention of EMR modifications can be combined with a weaker intervention based on educational sessions to create clinically meaningful and sustainable results through the use of quality improvement techniques and human factors engineering principles.2 In an era where healthcare spending is at an all-time high and with foreseeable significant reimbursement changes with the adoption of the Affordable Healthcare Act, healthcare institutions will need to continue to find ways to provide smarter care at a smaller price. 3 The lessons from this article could easily be applied to countless other clinical scenarios such as inappropriate ordering of head CTs in the setting of mild trauma 4 and inappropriate use of hepatocellular screening guidelines in patients with hepatitis C cirrhosis, 5 simply to name two.The authors successfully demonstrate how a low-cost multimodality intervention can provide exceptional cost savings without compromising clinical care. What is more, the cost savings cited likely are an underestimate given the implied cost savings of unnecessary additional testing such as cardiac stress tests and heart catheterizations. We should all take a cue from the authors to evaluate our daily clinical practices within our own institutions to improve the cost and quality of the care we deliver.

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CT Overuse for Mild Traumatic Brain Injury

Cited by 105 publications

References 45 publications

Computed tomography use in minor head injury: attitudes and practices of emergency physicians, neurosurgeons and radiologists in Turkey

Computed tomography use in minor head injury: attitudes and practices of emergency physicians, neurosurgeons and radiologists in Turkey

Traumatic brain injury: A case-based review

Capsule Commentary on Larochelle et al., Reducing Excess Biomarker Testing at an Academic Medical Center

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